Al-Mayouf Sulaiman M, Fallatah Rehab, Al-Twajery Mohammed, Alayed Tareq, Alsonbul Abdullah
Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Pediatric Intensive Care Unit, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Int J Pediatr Adolesc Med. 2019 Dec;6(4):142-145. doi: 10.1016/j.ijpam.2019.07.003. Epub 2019 Jul 9.
To report the outcome of children with rheumatic diseases admitted to pediatric intensive care unit (PICU) in a tertiary hospital.
Database from PICU and pediatric rheumatology section used to retrieve all candidate patients admitted to PICU from June 2000 to December 2017. Medical records of all enrolled patients reviewed for diagnosis, organ involvement, reason of PICU admission, the length of stay, and outcome.
Twenty-five patients (17 female, 8 male) with total of 41 admissions identified. The median PICU stay was 13.5 days (range, 3-24). The most frequent diagnoses were systemic lupus erythematosus (SLE) (48%), followed by systemic vasculitis (16%). Most admissions were from the medical ward (68.3%), while 24.4% from the emergency room. The main reason of PICU admission was a disease flare or related complications (48.8%), followed by infection (34.2%). Fifty one percent of the admissions were due to respiratory dysfunction, 46% required non-invasive respiratory support while 38% was in need for mechanical ventilation. During PICU stay, anti-microbial agents used 90.3%, immunosuppressive treatment adjustment 75.6%, anti-hypertensive 24.4% and vasopressors 12.2%. Twelve patients (48%) fully recovered and 40% partially recovered while three patients died during their PICU stay. The causes of death were macrophage activation syndrome complicated by sepsis in two patients and advanced pulmonary hypertension in one patient.
Our data showed that children with rheumatic diseases, particularly SLE, are mostly admitted to PICU with serious disease exacerbation or severe infection. To improve the outcome, early diagnosis of critical condition and proper intervention are fundamental in reducing mortality.
报告在一家三级医院儿科重症监护病房（PICU）收治的风湿性疾病患儿的治疗结果。
利用PICU和儿科风湿病科室的数据库，检索2000年6月至2017年12月期间收治入PICU的所有候选患者。查阅所有入选患者的病历，了解诊断、器官受累情况、入住PICU的原因、住院时间和治疗结果。
共确定25例患者（17例女性，8例男性），总计41次入院。PICU住院时间中位数为13.5天（范围3 - 24天）。最常见的诊断是系统性红斑狼疮（SLE）（48%），其次是系统性血管炎（16%）。大多数入院患者来自内科病房（68.3%），而24.4%来自急诊室。入住PICU的主要原因是疾病发作或相关并发症（48.8%），其次是感染（34.2%）。51%的入院是由于呼吸功能障碍，46%需要无创呼吸支持，38%需要机械通气。在PICU住院期间，使用抗菌药物的占90.3%，调整免疫抑制治疗的占75.6%，使用抗高血压药物的占24.4%，使用血管活性药物的占12.2%。12例患者（48%）完全康复，40%部分康复，3例患者在PICU住院期间死亡。死亡原因是2例患者巨噬细胞活化综合征合并败血症，1例患者晚期肺动脉高压。
我们的数据表明，患有风湿性疾病的儿童，尤其是SLE，大多因严重疾病加重或严重感染而入住PICU。为改善治疗结果，早期识别危重症并进行适当干预是降低死亡率的根本。
